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Current Research and Scholarly Interests

Clinical interests include autonomic disorders, small fiber neuropathies and the development of effective methods of testing and treating these disorders. Prior work has focused on small fiber painful and autonomic neuropathies; syndromes of orthostatic intolerance and syncope; gastrointestinal motility dysfunction; cyclic vomiting; protacted Gastroesophageal Reflux; non-allergic rhinitis syndromes; and the relationship between the autonomic nervous system and normal or abnormal sleep. Additional areas of interest include the neurology of phonation and swallowing disorders, and peripheral nerve injury and repair.

Abstract

Neurogenic chronic cough is currently a diagnosis of exclusion. We hypothesized that surface-evoked laryngeal sensory action potential (SELSAP) testing could be used to help establish a diagnosis of laryngeal sensory neuropathy as a cause of chronic cough, based on altered SELSAP waveform morphology.Retrospective cohort study.Laryngeal electromyographic (EMG) data including SELSAP waveform testing from patients with chronic cough were directly compared with a control population without significant laryngeal symptoms, and statistical analysis of unilateral and bilateral neuropathy injury subgroups was performed.Thirty patients with a chief complaint of chronic cough underwent laryngeal EMG testing since January 2000 with needle EMG and surface nerve conduction studies. SELSAP waveform analysis of unilateral and bilateral laryngeal neuropathy demonstrated significantly lowered median SELSAP peak amplitude compared with controls (P

Abstract

Background After nerve injury, an influx of calcium exceeds the homeostatic capacity, which damages peripheral nerves. Previous studies identified that following nerve crush, function improves as calcium levels normalize.Methods Electrophysiological analysis was performed to measure the compound muscle action potential of 15 patients' damaged nerves. These samples were evaluated for calcium level and also stained with a Luxol fast blue and neurofilament antibodies to evaluate the myelin sheath and neurofilaments of the nerves. Based on the Sunderland scale, we identified three exclusive types of peripheral nerve injury groups.Results There was a correlation between histopathological damage and calcium levels of 0.81 (p < 0.005). The average relative fluorescence units (RFUs) was 235.28 ± 19, which corresponds to 5.3 × 10-7 M of calcium, five times the normal value.Conclusion Our study shows promising clinical implications via faster pathology results by the RFU technique. This approach of calcium staining, though still in clinical trials, offers significant clinical application, allowing physicians to get the clinically diagnostic nerve injury degree faster and will also facilitate better strategies for further treatment or future surgeries.